| Skin assessment |
1- Examine the skin of all patients upon admission and thereafter, daily, above all, before medical adhesive application and after its removal. |
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| 2- Assess skin integrity, its coloration, temperature, humidity, turgor, fragility, edema and signs of local irritation. |
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| 3- Previously recognize the types of skin injuries caused by medical adhesives (Mechanical: skin stripping, tension injury and friction injury. Dermatitis: irritant contact dermatitis and allergic dermatitis. Others: maceration and folliculitis). |
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| Identification of patients at risk |
4- Obtain patient history of known allergies and sensitivities, particularly to components of the medical adhesive. |
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5- Identify patients at risk through the following factors:
Extremes of age (older adults);
Underlying clinical conditions (diabetes, immunosuppression, renal failure, chronic venous insufficiency);
Dermatological conditions (dermatitis, eczema, underlying injuries);
Exposure to humidity;
Malnutrition;
Dehydration;
Dry skin;
Use of certain medications (chemotherapy, vasoconstrictors, long-term corticosteroids, anticoagulants);
Recurrent use of medical adhesive. |
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| Product selection |
6- Select the most appropriate adhesive product for patients’ skin considering its particularities assessed. |
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7- To choose the adhesive, consider:
Patients’ skin conditions;
Expected adhesive action (e.g., critical, non-critical device fixation, dressing, wound dressing);
Time of permanence of the adhesive product.
Adhesive properties (e.g., cohesiveness over time, softness, flexibility, strength);
Anatomical location/area (whether the site is flat, subject to movement or friction, exposure to moisture, exudate and/or body fluids);
Potential adverse effects of insufficient adherence
Adhesive failure when the purpose is fixing a critical device; |
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| Skin preparation |
8- Prepare the skin, making sure it is clean and dry; |
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| 9- Shave the hair, if necessary, preferably with scissors, avoiding using blades; |
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| 10- Avoid using products that increase adhesive adhesion to the skin (e.g., benzoin); |
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| 11- Consider using a barrier film before applying the medical adhesive (available in foams, wet wipes or sprays), especially in patients at risk of skin injury; |
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| 12- Wait for liquid solutions to dry completely when applied to the skin, in order to avoid moisture; |
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| Adhesive product application technique |
13- Apply adhesive without straining, pulling or stretching; |
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| 14- Use firm and gentle pressure to put the adhesive product in place, avoiding gaps and wrinkles; |
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| 15- Fold a small edge of the adhesive over itself to form a small flap that facilitates its removal later; |
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| 16- Apply adhesive only to the required area |
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| Removal technique |
17- Start removal from the edges of the adhesive product; |
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| 18- With the fingers of the opposite hand, support the skin, keeping it firm; remove the adhesive product slowly on itself in the direction of hair growth, keeping it horizontal and at a low angle close to skin surface. As the product is removed, continue to move the fingers of the opposite hand supporting the newly exposed skin; |
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| 19- Consider the possibility of using adhesive remover products (available in liquid solution, wipes, sprays); |
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| 20- The use of lotion, petrolatum or mineral oil can be considered as alternative products for removing the adhesive; |
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| Health professionals’ education |
21- Promote permanent education for health professionals, addressing:
Identification and recognition of medical adhesive-related skin injuries;
Skin preparation;
Application and removal techniques;
Use of skin barrier products and adhesive removers;
Strategies for skin injury prevention. |
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